Background: Open fractures of tibial shaft are important for the reason that they are most commonly fractured long bone in the body & subcutaneous location of the anteromedial surface of the tibia makes their management controversial. The precarious blood supply and lack of soft tissue cover of the shaft of the tibia make these fractures vulnerable to delayed union, nonunion, malunion and infection. The treatment of tibial fractures has developed from a strictly non-operative to a variety of operative techniques. While reamed Intramedullary nailing offer improved stability of the fracture, their use carries a theoretical risk of infection and nonunion as a consequence of disturbing endosteal blood supply. Recent reports suggest that the reaming is safe for grade I, II and IIIA open fractures of tibia. Material & Method: A total of 25 patients presented to Father Muller Hospital, Mangalore from Jan'06 to July'07 with type I and II open tibial shaft fractures were included in the study and all cases underwent debridement within 6 hours of admission and treated with reamed intramedullary interlocking nailing. They were reviewed at every 2 weeks for 6 weeks and then monthly post operatively and x-rays were repeated at 6,12,24 weeks to check for fracture healing. The average duration of follow-up was 32 weeks. Functional results were graded according to criteria by klemm & borner. Result:The average time to union was 19.68 weeks. Type I united in 18.86 weeks as compared to 20.5 weeks for Type II fractures. The average range of motion in the knee joint was 135.6 degrees. Full ankle motion was observed in 19 patients. One patient showed a loss >25° of motion at ankle compared to normal side while 5 patients showed < 25 0 loss of joint motion. 92% patients achieved good or excellent results, fair results were obtained in one patient & in one patient functional results were poor. Conclusion: Anatomical & functional outcome of open tibial fractures type I and type II treated with reamed intramedullary interlocking nailing is excellent to good and it is safe and effective technique for the management of Gustilo type I and type II.

Original Research Article Proximal humeral fractures are the second most common fractures of the upper extremity and 20% of them require surgical fixation either because they needs better shoulder mobility or because their fracture is more severe. PHILOS plate promises to provide good fixation and stability. This prospective study aims to evaluate the functional outcome in the subjects following surgery. After obtaining due ethical clearance, a prospective study was conducted from January 2017 to September 2018. Thirty patients were selected. Fracture was classified using NEER'S Classification. All the fractures were approached by Delto pectoral approach and fixation done under fluoroscopic guidance. Patients were followed up at 6 weeks, 3, 6 and 12 months with radiographical evaluation and clinical examination and outcome. All patients at their final assessment underwent radiological and functional evaluation using the CONSTANT score. Based on NEER'S classification, 8patients (26.7%) had 2 part fracture, 12patients (40.0%) had 3 part fracture and 10patients (33.3%) had 4 part fracture. 1 patient had delayed union, 1 patient had non union, 2 patients developed stiffness of shoulder, 1 patient had a superficial infection and 1 patient had varus malunion. We assessed the final functional outcome with CONSTANT-MURLEY score and found that 7(20.0%) patients had excellent, 11(36.7%) patients had good, 7(23.3%) patients had moderate and 5(16.7%) patients had poor outcome. The mean constant score (mean± s.d.) of patients was 70.1000± 13.0816. Surgical management of fracture proximal humerus with PHILOS plating has a good functional outcome. However, proper patient selection, thorough knowledge of the anatomy and biomechanical principles are the prerequisites for a successful surgery.

Background: Distal humerus fracture is one of the commonest fractures among young adults and which accounts for about 30% of all elbow fractures. The treatment of these fractures continues to the challenges for orthopedics despite of many advances in technique and implants. Different modalities like 1/3rd tubular plate, reconstruction plate, K wires, double tension band wiring, etc, have been tried. The new distal humerus locking compression plate (LCP) system allows angular stable fixation of these complex fractures with anatomically pre-shaped plates. Aims: Aim of this study is to assess the benefits of using locking compression plate (LCP) in the management of distal humerus fractures clinically and as well as functionally. Materials and Methods: A prospective study of 30 adult patients with closed distal humerus fractures were treated by locking compression plate in the department of Orthopaedics, RIMS, Ranchi, between June 2014 to Sep 2015. Variables of each patient were recorded and analysed with respect to age, sex, fracture type, mode of injury, limb involvement, associated injuries, timing and duration of operation, duration of hospital stay, follow up, complications and final outcomes. These patients were followed up at different intervals i.e. at 3 weeks for first 3 months, then at 6-weeks interval for next 6 months and then at 3-month interval. Results: The average age was 38.5 years and majority patients were men (60%). The right humerus was involved in majority (70%) of patients. The complete union was achieved in all patients which was confirmed by radiographically. Average time interval between admission of patients and surgery was 7.8 days (range 4-13 days). The average operative time was 82 minutes (range 70-100 min). All the fractures as well as the olecranon osteotomies united at 12-18 weeks (average 13.80 weeks). There were no any case of primary malposition or secondary dislocation was observed. Using the Mayo elbow performance score, the majority (53.33%) of patients were graded as excellent. There was no any patient reported with deep infection, implant failure, non-union of fracture site or olecranon osteotomy site. There were only three patients those reported superficial wound infection, which was treated with antiseptic dressing and antibiotics. Transient ulnar nerve palsy developed in only 2 (6.66%) cases and both were recovered with conservative treatment. Conclusion: Findings can be concluding that the treatment of distal humerus fractures is a challenging task. Anatomically pre-shaped distal humeral locking compression plate system facilitates operative reduction and stabilization of the fracture and may allow with good range of motion, and flexion and extension force.